Clinical and employment outcomes of carpal tunnel syndrome in oregon workers’ compensation recipients

We examined demographic, occupational, and treatment characteristics in 316 Oregon workers with carpal tunnel syndrome (CTS) to identify factors associated with clinical and employment outcomes. The goal of this hypothesis-generating study was to identify factors amenable to change through return-to-work programs. Mean claim duration numbered 217 days; median duration was 194 days. Sixty-one percent of workers received timeloss pay at some point during their claim. Workers having CTS surgery numbered 196 (62%). Variables predicting greater days of timeloss in workers with surgery (n=192) included: (1) decreased ability to “get along on income,” (2) attorney involvement, (3) fewer years education, (4) having bilateral surgery, (5) having physical therapy before surgery, (6) longer claim duration, and (7) hand-intensive occupational tasks (r²=36%, adjusted r²=34%). The interplay between occupational and non-occupational factors mandates a comprehensive approach to the evaluation and treatment of workers with CTS.     

The significance of work tasks for rehabilitation outcome after carpal tunnel surgery

Surgical treatment of carpal tunnel syndrome (CTS) is used over the world with reported good results. The long-term rehabilitation result in terms of postoperative difficulties in returning back to work after surgery, however, has not been carefully studied. Ninety-three consecutive patients under the age of 55 were followed up 2 years after they had carpal tunnel surgery. Thirty-eight patients had symptoms similar to the ones that caused the operation; 24 patients in the study had monotonous, repetitive jobs. Of those, there were 18 that still had symptoms in the operated hand and 12 were incapable of work, meaning they were on long-term sick leave or had early retirement pensions. This study indicates that further measures than surgery alone are needed to get some patients with CTS back to a long-term working life. This is most obvious in females who after carpal tunnel surgery, return to a job exposing them to repetitive, monotonous hand and arm movements.     

Workplace surveillance for carpal tunnel syndrome: A comparison of methods

A variety of screening procedures for carpal tunnel syndrome (CTS) were applied among workers in a manufacturing plant, and results were compared. The test procedures included a symptom survey, physical examination, limited electrodiagnostic testing at the wrists, quantitative vibratory threshold testing, 2-point discrimination, palmar pinch grip, and hand grip strength testing. When electrodiagnostic testing alone was used as gold standard, the sensitivity and positive predictive value (PPV) of physical examination findings and quantitative test procedures were no better than, and usually worse than, the results on the symptom survey alone. Variation of the constellation of symptoms (i.e., numbness, tingling, pain or burning) and the anatomic distribution of reported symptoms (i.e., fingers, hand, wrist, or forearm) for inclusion in the screening symptom definition of CTS yielded modest changes in the sensitivity and PPV of the symptom survey. However, addition of the requirement for nocturnal symptoms as part of the screening symptom definition for CTS resulted in substantially higher PPV with only slight reduction in sensitivity. These results suggest that, in the absence of electrodiagnostic testing, the simplest test, and the procedure with the highest sensitivity and PPV for CTS is a symptom survey alone. Quantitative test procedures (vibrometry, pinch grip strength, hand grip strength) and physical examination for findings consistent with CTS (e.g., Phalen's test, Tinel's test, thenar muscle wasting, 2-point discrimination) appear to contribute little, if any, additional information when screening subjects in the work setting.     

Predicting outcomes of conservative treatment for patients with carpal tunnel syndrome: Group- and individual-based rehabilitation

ObjectiveTo identify predicting factors of treatment outcomes of a two stage group-based and then individual-based intervention programme for patients with carpal tunnel syndrome (CTS).MethodsA prospective cohort study where patients diagnosed with CTS were recruited from an out-patient occupational therapy clinic to join the two-stage CTS programme. The Stage-One programme consisted of splinting and educational talks in a group format, while the Stage-Two programme consisted of four weekly individual sessions providing psychosocial support, reinforcing correct ergonomics and mobilization. Baseline assessment on six potential predicting factors and four outcome measures was done for all patients. Patients were re-assessed at the end of the Stage-One and the Stage-Two programme. Analysis was done by binary logistic regression adjusted for baseline covariates.ResultsOne hundred and sixty-six patients completed the Stage-One programme and 46 patients also completed the Stage-Two programme. Results showed that the Chinese Symptom Severity Scale (SSS) baseline score was the only significant predictor for the Stage-One programme outcomes (AUC for ROC was 0.708) with an optimum cut-off score of 23.5. On the other hand, the Chinese QuickDASH baseline score was the only significant predictor for the Stage-Two programme outcomes (AUC for ROC was 0.801) with an optimum cut-off score of 27.4.ConclusionsThe significant predictor for the Stage One Programme was the Chinese SSS baseline score and that for the Stage Two Programme was the Chinese QuickDASH baseline score. The optimum cut-off scores identified may be applied clinically to guide client-centered treatment planning.     

Carpal tunnel syndrome: Validation of an interview questionnaire on occupational exposure

The objectives of this study were 1) to summarize in a clinically meaningful way information on occupational risk factors for carpal tunnel syndrome (CTS), and 2) to test a questionnaire on risk factors that could be used by physicians with their patients. For the two objectives, a systematic literature review was performed and synthetized graphically, and a questionnaire was developed and administered to 238 patients who underwent release surgery for CTS. Patients were classified in four groups according to the incidence rate of CTS surgery in their occupation. Answers to the questionnaire on exposure to risk factors for CTS were compared between these four groups with the hypothesis that the group with the highest incidence would report the heaviest exposure. The results showed that questioning workers on the amount of force required to perform tasks that are “especially demanding” for the wrists or hands is both useful clinically and valid to be used by the clinician to make a judgement on the occupational nature of CTS. Repetitiveness and segmental exposure to vibrations or to cold are potentially useful and will need further validation. There is no evidence at present that posture or motion of the wrists is potentially useful to describe occupational exposure when questioning patients with CTS. Am. J. Ind. Med. 33:224–231, 1998. © 1998 Wiley-Liss, Inc.     

A comparison of data sources for the surveillance of work-related carpal tunnel syndrome in Massachusetts

BACKGROUND: This study examined whether a state surveillance system for work-related carpal tunnel syndrome (WR-CTS) based on workers' compensation claims (Sentinel Event Notification System for Occupational Risks, SENSOR) and the Annual Survey of Occupational Injuries and Illnesses (SOII) identified the same industries, occupations, sources of injury, and populations for intervention. METHODS: Trends in counts, rates, and female/male ratios of WR-CTS during 1994-1997, and age distributions were compared across three data sources: SENSOR, Massachusetts SOII, and National SOII. SENSOR and National SOII data on WR-CTS were compared by industry, occupation, and injury source. FINDINGS: Due to small sample size and subsequent gaps in available information, state SOII data on WR-CTS were of little use in identifying specific industries and occupations for intervention. SENSOR and National SOII data on the frequency of WR-CTS cases identified many similar occupations and industries, and both surveillance systems pointed to computer use as a risk factor for WR-CTS. Some high rate industries identified by SENSOR were not identified using National SOII rates even when national findings were restricted to take into account the distribution of the Massachusetts workforce. CONCLUSIONS: Use of national SOII data on rates of WR-CTS for identifying state industry priorities for WR-CTS prevention should be undertaken with caution. Options for improving state SOII data and use of other state data systems should be pursued.     

Clinical determination of work-relatedness in carpal tunnel syndrome

The purpose of this study was to determine the diagnosis and work-relatedness of carpal tunnel syndrome (CTS) using standardized criteria in a series of cases that were referred for an independent medical examination with a prior diagnosis of work-related CTS. using a liberal case definition, only 65% of cases had CTS. Using Wisconsin's worker's compensation criteria for work-relatedness, only 55% of the cases had any work-related disorder, while only 37% of the cases had work-related CTS. Duration of exposure was not significantly associated with work-related vs. non-work-related CTS. It was noted that the development of non-work-related CTS cases occurred uniformly across the various durations of exposure, as if unrelated to exposure. The symmetry of the disorder was unrelated to work-relatedness, provided that the symmetry of the disease matched the symmetry of the exposure. Personal characteristics, such as obesity and diabetes, revealed no statistically significant associations with work-relatedness or CTS. The present findings illustrate application of a standard procedure for determining the work-relatedness of CTS in a series of cases referred for independent medical examination. The results indicate that CTS is often, overdiagnosed and inaccurately linked to work. While the results may be limited by the method of determining work-relatedness, the findings indicate the importance of careful consideration of criteria for CTS and work-relatedness. When such an approach is taken, more targeted clinical management of the patient and appropriate intervention in the workplace should result.     

Use of ultrasonography in monitoring work-related carpal tunnel syndrome: A case report

Carpal tunnel syndrome (CTS) is a syndrome whose diagnosis is well established. One cause could be occupational factors, while others have no relation to work or the work environment. We present in this article a case report regarding a worker affected by CTS, which is of interest concerning the sensitivity of ultrasonography and electroneurography, applied as diagnostic methods, related in our protocol to the variations in occupational exposures. The case reports an agricultural worker, whose tasks required repetitive and high frequency movements of the hand-arm. Diagnosis of CTS used ultrasonography and electroneurography techniques. In our opinion, the clinical evolution of CTS encompasses three “work-related” phases (preclinical phase; phase of nerve compression; phase of irreversible damage). Ultrasonography provides greater information about the evolution of CTS, as well as other cumulative trauma disorders, and is able to discern tendinitis of flexors causing a compression on the median nerve in the carpal tunnel. Am. J. Ind. Med. 33:560–564, 1998. © 1998 Wiley-Liss, Inc.     

The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State

BACKGROUND: The long-term earnings losses borne by injured workers, beyond those covered by workers' compensation insurance, are rarely estimated. The post-claim earnings of a cohort of carpal tunnel syndrome (CTS) claimants are tracked over a period of 6 years and compared to the earnings of claimants with either upper extremity fractures or dermatitis. METHODS: Quarterly earnings records of 4,443 workers in Washington State who filed claims with the State Fund in 1993 or 1994 for CTS are compared to those of 2,544 with upper-extremity fracture claims and 1,773 with medical-only dermatitis claims. Multivariate regression was used to identify the effect of injury type on earnings from that of other potential predictors. RESULTS: CTS claimants recover to about half of their pre-injury earnings level relative to that of comparison groups after 6 years; they also endured periods on time-loss three times longer than claimants with upper extremity fractures. CTS surgery claimants had better outcomes than those who did not have surgery. Earnings recovery fractions among CTS claimants were better for workers who: (1) were younger; (2) had stable pre-claim employment; (3) lived in the Puget sound area; (4) worked for large businesses; (5) worked in non-construction/transportation industries; or (6) were in the higher pre-injury earnings categories. Cumulative excess loss of earnings of the 4,443 CTS claimants was 197 million dollars to 382 million dollars over 6 years, a loss of 45,000-89,000 dollars per claimant. This underscores the importance of prevention, early diagnosis, and accommodation for return to work.     

Pyridoxine hydrochloride treatment of carpal tunnel syndrome: a review

It has been hypothesized that idiopathic carpal tunnel syndrome (CTS) is a manifestation of vitamin B6 deficiency. Some claim that B6 supplementation can alleviate symptoms. Others argue that pain relief occurs because of vitamin B6's anti-nociceptive properties or because B6 supplementation addresses an unrecognized peripheral neuropathy. Few studies on CTS and B6 employed electrodiagnostic techniques in diagnosis, and few showed a correlation between symptoms and improved electrodiagnostic parameters with supplementation. Other studies failed to measure or estimate B6 levels. Nevertheless, it appears reasonable to recommend vitamin B6 supplementation to people with CTS. Some patients will improve symptomatically with low risks of toxicity in recommended doses.